The Effect Of Laparoscopic Spleen-preserving Distal Pancreatic Resection With The Warshaw Technique Vs The Kimura Technique:a Meta-analysis

Objective：To evaluate the clinical effect of laparoscopic spleen-preserving distalpancreatic resection with and without splenic vessel ligation,and to providean objective evidence for clinical treatment.Methods：The following databases as MEDLINE、EMbase、CBM、CNKI andWanFang (from1990.1-2015.1) were searched by computer,and tracedrelated references. Non-randomized controlled clinical trial that researchedthe effect of laparoscopic spleen-preserving distal pancreatic resectionwith and without splenic vessel ligation were collected. The latest RevMan5.3software provided by the Cochrane Handbook was used for Meta-analysis.Results：6non-randomized controlled clinical trials with492patients wereincluded. The meta-analysis detected no statistically significant differencebetween the two groups in the operation time [MD=-18.02，95%CI（-52.01，15.97），P=0.30]、the postoperative hospital stay [MD=0.55，95%CI（-0.81，1.92），P=0.43]、 pancreatic fistula[MD=1.19，95%CI（0.71，1.99），P=0.52]、the diameter of tumor[MD=7.94，95%C（I-2.87，18.74），P=0.15]、the total complication [MD=1.30，95%C（I0.83，2.03），P=0.25] and the postoperative spleen resection [MD=5.61，95%CI（0.90， 35.08），P=0.07]. The warshaw technique significantly reduced the amountof blood loss [MD=-83.56，95%CI（-160.42，-6.69），P=0.03],but thesplenic infarction [MD=6.67，95%CI（3.42，13.01），P＜0.00001] andthe gastric fundus varices [MD=11.23，95%C（I4.47，28.20），P＜0.00001]of the warshaw technique were more than the kimura technique.Therewere a statistically significant difference between the two groups.Conclusion：Compared with the kimura technique，the blood loss of the warshawtechnique was less, but the splenic infarction and varices of gastric funduswere more. No statistically significant differences were found in the otherindicators such as operation time、the postoperative hospital stay、the totalcomplication、pancreatic fistula、the diameter of tumor、the postoperativespleen resection. So,for the similar effect,the warshaw technique can beused to laparoscopic spleen-preserving pancreatic resection like the kimuratechnique,but this requires the strict control of the indications and theskilled of surgical techniques,to avoid postoperative splenic infarction,varices and other complications.